超声引导下臂丛神经阻滞联合喉罩全麻在肩关节镜手术的应用

Application of brachial plexus block combined with laryngeal mask general anesthesia under ultrasound guidance in shoulder arthroscopic surgery

目的:观察超声引导下臂丛神经阻滞联合喉罩全麻在肩关节镜手术中的应用。方法:择期行单侧肩关节镜下肩袖破裂修补手术的患者60例,采用随机数字表法分为两组,每组30例。观察组先行超声引导下肌间沟臂丛神经阻滞后再行喉罩全身麻醉;对照组行喉罩全身麻醉。两组均采用七氟烷+瑞芬太尼维持麻醉。观察两组术中瑞芬太尼的用量、出血量和术后2h、6h、12h活动VAS评分及满意度。结果:观察组术中瑞芬太尼用量和出血量少于对照组,两组比较差异有统计学意义(P<0.01);两组术后活动VAS评分有随时间变化的趋势,分组和时间有交互效应,观察组术后2h、6h、12h活动VAS评分均低于对照组,满意度高,两组比较差异有统计学意义(P<0.01)。结论:超声引导下臂丛神经阻滞联合喉罩全麻在肩关节镜手术中减少阿片类镇痛药使用、血压平稳易于控制、从而减少出血量,术后镇痛效果好,满意度高。

Objective:To observe the application of ultrasound guided brachial plexus block combined with laryngeal mask general anesthesia in shoulder arthroscopic surgery.Methods:60 patients were selected for repair of rotator cuff rupture under single shoulder arthroscope,and were divided into two groups with 30 cases each.The observation group was guided by ultrasonography before the intermuscular plexus nerve obstruction was delayed and the laryngeal mask was anaesthetized.The control group underwent general anaesthesia of the larynx mask.In both groups,sevoflurane+rifentanyl was used to maintain anesthesia.To observe the dosage,bleeding volume,activity VAS score of 2 h,6 h and 12 h of Ruifentaini in the two groups.Results:The amount of reifentanyl and bleeding in the group were less than those in the control group,and the difference was statistically significant(P<0.01);The VAS score of postoperative activity in the two groups had a tendency to change with time,and there was an interaction effect between group and time.The VAS score of 2 h,6 h,and 12 h activity after the observation group was lower than that of the control group,and the satisfaction was higher.The difference between the two groups was statistically significant(P<0.01).Conclusions:Ultrasound-guided brachial plexus block and laryngeal mask general anesthesia in shoulder arthroscopic surgery to reduce the use of opioid analgesics,blood pressure is stable and easy to control,thereby reducing the amount of bleeding,postoperative analgesia effect is good,and satisfaction is high.